That’s why the program is so easy to learn. It had to be. We had trainees for brief rotations and they had to begin using the program immediately. No one had time for lengthy training sessions or thick instruction manuals. We needed an EHR that trainees could learn in about 20 minutes.
Our experience with trainees forced us to create clear paperwork templates and compliance tracking. We needed to teach interns and residents the complexities of each type of form as well as the sequence and timing to complete forms. We designed the program so it guided the trainees (and new staff, for that matter) through the workflow the Office of Mental Health required. When we fully implemented our EHR system, we were able to eliminate an orientation course on clinical documentation. We also saved supervisory hours that had been devoted to teaching about paperwork requirements.
We had to account for a host of other contingencies that arise with trainees. The program had to recognize whose paperwork needed a countersignature and whose didn’t. It had to know which trainees had credentials we could bill under and whose services could only be billed under a supervisor’s name. For security purposes, we had to consider which areas of the program and which parts of the clinic database students with various credentials could access.
Because various credentialing bodies for each of the professions we trained regularly made site visits, we needed to produce specialized reports that listed the number of cases each trainee carried, what diagnoses those patients were assigned, the total number of sessions a particular student was involved with, and the treatment modality (individual psychotherapy, pharmacotherapy, group therapy, etc.). Without an EHR smart enough to track all of these dimensions, we never would have been able to meet our obligations.
Since we often had multiple students with multiple supervisors working with multiple family members, treatment could go awry without a fully transparent system. If I was supervising a psychology intern who was treating a child whose mother was treated by a psychiatry fellow (who also had a supervisor), I wanted to know that everyone had access to everything in the file. The intern had to be aware that the psychiatry fellow had changed medications or that the mother had recently become more depressed. As a clinic director, I wanted everyone to be working off the same proverbial page.
I also wanted trading drafts of progress notes and other reports to be as efficient as possible. Prior to ClinicTracker, I saw folders piling up in a supervisor’s mailbox, waiting for review and signatures. In a more efficient system, a trainee could write a report, send it electronically to a supervisor, and track whether that supervisor had reviewed the documentation. It had to be easy for supervisee and supervisor to communicate easily. I also wanted my supervisors to know where trainees stood with their paperwork completion. No one wanted to find out that a student had left the rotation without submitting treatment plans or discharge notes. ClinicTracker’s sophisticated internal messaging and alert system grew out of the need for a practice management system that facilitated collaboration and accountability.
While working with trainees posed many EHR challenges, it also presented wonderful opportunities. Imagine that a child psychiatry fellow must complete a research project. She’s interested in whether mothers with a history of depression are more likely to overrate their child as depressed. No sweat. You have a computer database with hundreds of cases, all of which contain information about demographics, diagnoses, rating scale data, and dozens of other variables. Even better: You designed the EHR so that it was easy to export the data you wanted into an Excel format that the trainee could import into a statistical package. All of a sudden, conducting clinical research went from standing for hours at a file cabinet with pencil in hand to simply pressing a few computer keys.
I shake my head when I hear that an administrator in an academic setting wants to adopt a simple system, free of bells and whistles because they're setting up the agency up for EHR failure. Workflows and tracking requirements in a training clinic are complicated and require sophisticated systems that are easy to use. That’s why ClinicTracker is truly the better way.